[Against the principle surgical indications in inguinal hernia]

It is generally accepted that most inguinal hernias should be operated electively. This study presents a risk calculation challenging this view. Three strategies are presented: prophylactic indication on principle (A), elective operation in every second case (B), and operation in case of strangulation only (C). On the basis of available epidemiological data it is calculated that, for the male German population aged 65 years and over 69,954 (A), 36,292 (B), and 2630 (C) inguinal hernia repairs would be necessary annually; 167 (A), 145 (B) and 123 (C) perioperative deaths would occur, connected with 1702 (A), 1373 (B) and 1048 (C) years of life lost, respectively. Thus, operation of every inguinal hernia would result in a (small) reduction of life expectancy. These data provide evidence that in elderly patients the indication for operative treatment of inguinal hernias should depend upon symptoms and suffering. There is no reason to operate on asymptomatic patients because of a presumed risk of strangulation.